RURAL OPERATIVE SKILL TRACKDAVID KERMODE DO FACOSMERCY MEDICAL CENTER DES MOINES IOWA
TARA BLALOCK, AUD, DOMERCY FAMILY MEDICINE RESIDENCY-PGY1
HOW I LANDED HERE?
Roots!!
Background
WhyFamilyMedicine?
• ObstetricsandPeds• Widescopeofpractice• RuralandGlobalHealth• HealthPolicy• It’smycalling!
DreamJob!!
• Ruralsetting• HeavyObstetrics• ManyProcedures• Opportunitytooperate• Becomeatrustedmemberofacommunity• Participateinhealthpolicy• Havethetoolstoserveglobally
Proceduresyousay?Operateyousay?
• C-sections• D&C• TL• Scopes• Appy• Leeps• AssistGS• WhynotOBorGS?
Willitbehard?
• YES!• 4th year• Relationshipswithspecialists• Highstandards• Highexpectations• Comfortzone• Changingaculture• Choosingtherightperson
But…
Wewillbevictorious!!!
THE SPACE BETWEENF.P. (REST)
RURAL PATIENT
General SurgeonOB/GYN
PARTNERSHIP
WHAT “THEY” THINK VS WHAT WE THINK
WORKING TOGETHER
SKILL SET NEEDED EVERYWHERE
USING THE GOOD WORK OF OTHERS
PERCEPTION VS REALITY
CORE PROCEDURES LISTHead and NeckChestAbdomenPelvis
ScrotumExtremitiesOperative Obstetrics
HEAD AND NECKT & AI&D peritonsillar abscess
CHESTTube Thoracostomy
ABDOMENEndoscopy and interventionAppendectomyHerniorraphyHemorrhoids Fistulas perianal/rectal abscesses, warts
PELVISDiagnostic laparoscopyTubal ligationD&CHysteroscopy
Ectopic PregnancyBartholin abscess
SCROTUMVasectomyCircumcisionTesticular torsion
EXTREMITIESSmall skin flapsDigital AmputationCarpal TunnelExtensor tendon repair
GanglionectomyTrigger finger
OPERATIVE OBSTETRICSVaccum deliveryManual rotationLow forcepsC section
Repair or 3rd and 4th degree perineal tearsManual removal of retained placental Repair of bladder injuries D&C
DESIGN/BUILDConsensus Opinion of our working group is that this cannot be done in the context of a 3 year FP residency
We have progressed to developing a 4th year fellowship after Family Medicine Residency
Our current opinion is that a cirriculum can be built into a 2nd
and 3rd year FM residency that will enhance the trainees transition into this fellowship
?????1. Can you think of any other procedures that need to be taught?
2. How much of a need it there for this skill set in your community?
3. Do you think that patients would accept these practitioners in your community?4. How much cooperation would these practitioners have in developing “communities” of practice in your area with referring OB/GYN and general surgeons?
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